INTERVENTION DEVELOPMENT USING PALLIATIVE CARE CLINICAL PRACTICE GUIDELINES CONCERNING SPIRITUALITY

Abstract Nurses may be reticent to engage older adult cancer patients in spiritual histories despite evidence of improved health outcomes citing lack of education, skills, and time as barriers. Few interventional studies target these barriers using the Clinical Practice Guidelines for Quality Palliative Care as a framework for providing spiritual care excellence. Lift the Spirit, an enhanced educational communication intervention, integrated the guidelines for assessing and respecting patient and family spiritual beliefs, provider self-reflection, and spiritual screening and assessment using a validated instrument. The mixed-methods pilot study aimed to assess the feasibility and acceptability of Lift the Spirit. A purposive sample of nurses (n = 17) viewed an educational module, role-played conducting spiritual histories using the Faith, Importance, Community, Address (FICA) © instrument, and completed debriefing interviews. Pre/post outcome measures of Spiritual History Knowledge and Spiritual History Self-Efficacy were analyzed using a Wilcoxon paired signed-rank test. Debriefing interview data were content analyzed. The Theoretical Framework of Acceptability was used to content code and identify acceptability-related content. There were significant differences between pre and post knowledge and self-efficacy scores, respectively (Wilcoxon Signed-Ranks: Z = -3.18, p = 0.002; and Z = -3.20, p = 0.001). Qualitative findings supported the feasibility and acceptability of Lift the Spirit; participants found the FICA© instrument and role-playing especially helpful. Preliminary findings suggested Lift the Spirit was feasible, acceptable, and positively impacted knowledge, skills, and self-efficacy. The utility of an intervention like Lift the Spirit to improve older adult cancer patient outcomes was demonstrated.

Logistic regression analysis was performed to test the interaction effect of daily affect mean levels and variability on depression.We found a significant interaction effect between PA mean levels and variability on depression status at follow-up.For individuals with high PA levels, higher PA variability was associated with higher odds of developing depression, after adjusting for depression and anxiety disorder at baseline.For NA, we only found main effects where higher NA variability was associated with higher odds of depression at follow-up.Findings suggest fragile high PA (i.e., variable high PA) may be a significant predictor of depression, highlighting the need for understanding PA as multidimensional construct.

SPIRITUALITY AND RELIGIOSITY IN BRAZILIAN AND AMERICAN OLDER ADULTS, CHARACTERISTICS AND NURSING CARE APPROACH
Chair: Angelo Jose Bós Discussant: Amelia Gallagher This symposium aims to understand two aspects of spirituality and religiosity: the importance of religiosity for older adults, in a population-based study, and a proposal approach for nursing care in cancer patients: Lift the Spirit approach.
In the Brazilian study, we will show that religiosity is significantly associated with sex, race, level of education, perceived health status and non-transmittable chronic diseases, including cancer.The results evidence the important role of religious faith in the Brazilian older adult's health.We concluded that religion and spiritual approaches should always be considered for older adults.In the American study, we will show that preliminary findings suggested Lift the Spirit was feasible, acceptable, and positively impacted knowledge, skills, and self-efficacy.The innovative combination of synchronous and asynchronous online delivery of the intervention and data collection methods has implications for research, education, and clinical practice.Lift the Spirit delivered on an entirely online format is widely accessible and convenient to researchers, educators, and practitioners, as well as participants and students.Equipping nurses to conduct spiritual histories through an intervention like Lift the Spirit is crucial to overcoming a significant barrier to providing spiritual care.Nurses may be reticent to engage older adult cancer patients in spiritual histories despite evidence of improved health outcomes citing lack of education, skills, and time as barriers.Few interventional studies target these barriers using the Clinical Practice Guidelines for Quality Palliative Care as a framework for providing spiritual care excellence.Lift the Spirit, an enhanced educational communication intervention, integrated the guidelines for assessing and respecting patient and family spiritual beliefs, provider self-reflection, and spiritual screening and assessment using a validated instrument.The mixed-methods pilot study aimed to assess the feasibility and acceptability of Lift the Spirit.A purposive sample of nurses (n = 17) viewed an educational module, role-played conducting spiritual histories using the Faith, Importance, Community, Address (FICA) © instrument, and completed debriefing interviews.Pre/post outcome measures of Spiritual History Knowledge and Spiritual History Self-Efficacy were analyzed using a Wilcoxon paired signed-rank test.Debriefing interview data were content analyzed.The Theoretical Framework of Acceptability was used to content code and identify acceptability-related content.There were significant differences between pre and post knowledge and self-efficacy scores, respectively (Wilcoxon Signed-Ranks: Z = -3.18,p = 0.002; and Z = -3.20,p = 0.001).Qualitative findings supported the feasibility and acceptability of Lift the Spirit; participants found the FICA© instrument and roleplaying especially helpful.Preliminary findings suggested Lift the Spirit was feasible, acceptable, and positively impacted knowledge, skills, and self-efficacy.The utility of an intervention like Lift the Spirit to improve older adult cancer patient outcomes was demonstrated.Religiosity is a strong factor related to health in older adults, which could positively affect physical and mental health.We aimed to observe the association between sociodemographic and clinical factors and the religiosity level in older adults.This is a secondary analysis of the Brazilian Older-adults Health Longitudinal Study (ELSI-Brazil) run by Fiocruz Institute in 2015 using a national sample of older adults (60+ year-old) population.The dependent variable was "How much the religious faith give meaning to your life?" and the independent were: sociodemographic (agegroup, sex, race, marital status, and scholarly) and clinical (auto perception of health and non-transmittable chronic diseases diagnose -NTCD) characteristics, tested by Chi-Square with p<0.05 significant level.The total sample accounted for 4,669 participants, 4,080 (87.4%) answered that faith gives a lot of meaning to their lives.This percentage was significantly higher in women (91.2% vs 81.8% in men, p=0.003), indigenous race (95%, p=0.003), lower scholarly (p<0.001) and better auto perception of health (p=0.021).NTCD significantly related to higher importance of religiosity were hypertension (88.3%), dyslipidemia (90.0%), angina (93.9%), arthritis (90.5%), osteoporosis (91.0%), depression (88.7%), and cancer (90.4%).Participants with Diabetes (86.1%), pneumopathies (85.9%), and Parkinson (86.7%) had significant lower levels of religiosity.Religiosity had a significant association with sex, race, scholarly, health auto perception and NTCD, including cancer.The results evidence the important role of religious faith in the Brazilian older adult's health.We concluded that religion and spiritual approach should always be considered to older adults.

HOW IMPORTANT IS IT TO PRAY AND MEDITATE FOR BRAZILIAN OLDER ADULTS? SOCIODEMOGRAPHIC AND CLINICAL CHARACTERISTICS
Mariana Salecker 1 , Yolanda de Souza 1 , and Angelo José Bós 2 , 1. Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul,Brazil,Porto Alegre,Rio Grande do Sul,Brazil Praying and meditating are considered spiritual expressions, but little is known about this importance among older adults.Therefore, this abstract aim to understand the frequency and the sociodemographic and clinical characteristics related to the importance given by the Brazilian older adults to praying and meditating.This is a secondary analysis of the transversal data of the Older Adults Health Longitudinal Study, made by Fiocruz in 2015.The dependent variable is: "How much daily praying and meditating is important to you?" Independent variables included: sex, age, educational level, marital status, race, and self-perception of health.The relation between the variables were tested by Chi-Square, considering p<0.05 significant.Praying and meditating everyday were important in 87.6% of the participants.Higher percentages were noticed between the ages of 60 to 69 years old (88.8%) and the ages 80 to 89 years old (88.1%, p<0.001), women (91.6%, p<0.001), widows (90.8%, p<0.001), indigenous (89.1%, p<0.001), with primary school complete (90.5%, p<0.001) and with regular auto perception health (88.4%, p=0.051).We conclude that there is higher than expected frequency of Brazilian older adults who consider important praying and meditating.They are more likely to be women, widow, indigenous, younger, less educated and have regular selfperception of health.Nurses can relieve spiritual suffering in older adult cancer patients through spiritual histories, yet may be reticent to engage in spiritual conversations.The qualitative aim of Lift the Spirit, a pilot feasibility and acceptability study, was to explore factors affecting cancer nurses' perceptions of the barriers and facilitators to conducting spiritual histories in clinical practice.Lift the Spirit, an enhanced educational communication intervention, was designed to equip nurses with the knowledge, skills, and attitudes to conduct spiritual histories.A purposive sample of nurses (n = 17) independently engaged in an online multimedia course, Spiritual Assessment in Clinical Practice, then synchronously role-played conducting a spiritual history in dyads (nurse/ patient), engaged in a skills performance, and participated in Debrief Interviews.Qualitative data were collected during Debriefing Interviews using the Debrief Interview Guide.Interpretive description guided the qualitative content analysis of Debrief Interview data.Structural coding was used to sort data into barriers and facilitators on the first pass.Next,

FAITH IS SIGNIFICANTLY ASSOCIATED TO SOCIODEMOGRAPHIC AND CLINICAL CHARACTERISTICS IN BRAZILIAN OLDER ADULTS Yolanda
de Souza, Angelo Jose Bós, and Mariana Salecker, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil